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109H Are You Ready for Patient Tracers

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CQI/Readiness Director. VA Midwest Health Care Network (VISN 23) 2. 109H - Are You Ready For Tracers? This is 1.5 ... 109H - Are You Ready For Tracers? Please, ... – PowerPoint PPT presentation

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Title: 109H Are You Ready for Patient Tracers


1
109H Are You Ready for Patient Tracers?
  • Shirley Simons RN, MSN, CPHQ
  • CQI/Readiness Director
  • VA Midwest Health Care Network (VISN 23)

2
109H - Are You Ready For Tracers?
  • This is 1.5 Hours Hands-On class
  • Restrooms are located…
  • Cell Phones
  • Please turn off or change to vibrate.
  • If you must answer a call, please leave the room.

3
109H - Are You Ready For Tracers?
  • Please,
  • No questions during the presentation (except
    instructional)
  • Questions written on the 3X5 cards will be
    answered at the conclusion of the presentation
  • For questions not answered during the session,
    both questions and answers will be available on
    the web

4
109H - Are You Ready For Tracers?
  • If you get lost, raise your hand.

There are room assistants to help you.
5
109H - Are You Ready For Tracers?
  • Priority Focus Process (PFP)
  • Priority Focus Areas (PFA)
  • Process, system, or structure that significantly
    impacts the quality safety of care
  • Clinical Service Groups (CSG)
  • Categories of patients/residents/clients or
    service for which data are collected

6
109H - Are You Ready For Tracers?
Priority Focus Areas
  • Assessment care/services
  • Communication
  • Credentialed Practitioners
  • Equipment Use
  • Infection Control
  • Information Management
  • Medication Management
  • Organizational Structure
  • Orientation Training
  • Rights Ethics
  • Physical Environment
  • Quality Improvement
  • Patient Safety
  • Staffing

7
109H - Are You Ready For Tracers?
  • Examples of Clinical Service Groups
  • Cardiology
  • Internal Medicine
  • Urology
  • General Surgery
  • Dialysis
  • Behavioral Health
  • Long Term Care
  • Residential Care

8
109H - Are You Ready For Tracers?
  • 2007 Top Joint Commission Findings
  • MM.2.20 Medication Storage
  • REQ.2C Critical Test Results
  • REQ.8A Medication Reconciliation
  • REQ.9B Fall Reduction Program
  • REQ.7A Hand Hygiene
  • REQ.3D Labeling of Medications
  • HR.1.20 Staff Qualifications

9
109H - Are You Ready For Tracers?
  • Top Joint Commission Findings 2008 1st Quarter
  • REQ.2C Critical Test Results
  • PC.8.10 Pain Assessment
  • EC.5.20 Life Safety Code
  • REQ.8A Medication Reconciliation
  • UP.1.C Time Out
  • REQ.7A Hand Hygiene

10
109H - Are You Ready For Tracers?
  • OIG Findings FY08 FYTD
  • Data Trending, Analysis Reporting
  • Improvement Based on Data
  • Hand-Off Communication
  • Medication Reconciliation
  • Medication Refrigerator Temperatures
  • Medication Storage

11
109H - Are You Ready For Tracers?
  • SOARS Findings FY07
  • Medication Reconciliation
  • Hand-Off Communication
  • Medication Refrigerator Temperatures
  • Medication Storage
  • Information Security

12
109H - Are You Ready For Tracers?
  • Common Findings
  • Medication Reconciliation (4)
  • Medication Storage (3)
  • Hand-Off Communication (2)
  • Medication Refrigerator Temps (2)
  • Critical Test Results (2)
  • Hand Hygiene (2)

13
109H - Are You Ready For Tracers?
  • The Added Value of Tracers
  • Readiness Tool
  • Focuses on Care/Service to Patient
  • Utilizes the Expertise of Front Line Staff
  • Assesses deployment
  • Identifies opportunities for improvement in care
    processes
  • Provides additional feedback to the facility and
    validates perceptions
  • Educational for staff

14
109H - Are You Ready For Tracers?
  • Elements of a Tracer
  • Observation of care processes
  • Care/Treatment Planning
  • Medication Management
  • Infection Prevention/Control
  • Communication/Interaction
  • National Patient Safety Goal implementation
  • Discussion of data used for improvement
  • Medical record review
  • EOC observations

15
109H - Are You Ready For Tracers?
  • Tracer Process
  • Choose a patient to trace
  • PFA/CSG Complete tracer
  • Following a specific topic (NPSG, Medication
    Management)
  • Meet with the nurse providing care to the patient
  • General information about the patient
  • Open CPRS for care and document review (nurse is
    the driver)
  • 30-60 minutes with the front line care staff
  • Discuss data related to patient care processes

16
109H - Are You Ready For Tracers?
  • Summary
  • Find out how your facility is using the tracer
    process for readiness
  • Volunteer to be involved
  • Focus on the patient/resident/client
  • Build sound process
  • Be Continually Ready!

17
109H - Are You Ready For Tracers?
  • Time for Questions
  • shirley.simons_at_va.gov

18
109H - Are You Ready For Tracers?
  • Instruction Slides for
  • CPRS Navigation

19
109H - Are You Ready For Tracers?
  • LOG IN
  • Access Code 01VEHU
  • Verify Code VEHU01

20
109H - Are You Ready For Tracers?
  • Admission Information
  • Open CPRS, using the Access Code of 01VEHU and
    Verify Code of VEHU01.
  • Double click on One,Patient.
  • The chart opens to the cover sheet. Look in the
    bottom right hand corner under,
    Appointments/Visits/Admissions and find the
    date and time of admission for 7a Gen Med
    (4-27-08 _at_ 1100).

21
109H - Are You Ready For Tracers?
  • Nursing Admission Assessment
  • Click on Notes tab.
  • Choose Nursing Admission Assessment.
  • About 10 lines down you will see, Patients
    Reason for Admission/Procedure.
  • On the 5th line below the Vital Signs you will
    see an entry about new allergies.
  • Move down five lines to Advance Directive.

22
109H - Are You Ready For Tracers?
  • Skin Assessment
  • Right click within the Nursing Admission
    Assessment note.
  • Choose, Find in Selected Note.
  • Type in skin and choose Find Next.
  • This takes you to the skin assessment.

23
109H - Are You Ready For Tracers?
  • Nutrition Screening
  • Right click within the Nursing Admission
    Assessment note.
  • Choose, Find in Selected Note.
  • Type in nutrition and click 3 times on Find
    Next.
  • This takes you to the nutrition assessment.

24
109H - Are You Ready For Tracers?
  • Fall Risk Assessment
  • The Fall Risk Assessment is located immediately
    below the Nutrition Assessment.
  • Review the entries and associated scores.
  • Verify the 0 for high risk medications
  • Click on the Meds tab.
  • Review Outpatient medications.
  • Find Metformin and Metoprolol.
  • Return to the Nursing Admission Assessment
    under the Notes tab. It should be at the same
    view as before accessing the Meds tab.
  • Note the total score of 90.

25
109H - Are You Ready For Tracers?
  • Medication Reconciliation
  • Verify that you are still in the Notes tab.
  • Select the Medication Reconciliation note.
  • Look toward the bottom of the note for the MED
    RECON entry.

26
109H - Are You Ready For Tracers?
  • Problem List
  • Click on the Problem List tab.
  • Note that each diagnosis should be identified as
    active or inactive with appropriate dates.

27
109H - Are You Ready For Tracers?
  • Learning Assessment
  • Verify that you are still under the Notes tab.
  • Choose the Nursing Admission Assessment note.
  • Right click within the note and select Find in
    Selected Note.
  • Type in Education and click two times on Find
    Next.
  • Review the education assessment information.

28
109H - Are You Ready For Tracers?
  • Pre-op Teaching
  • Choose the Nursing Surgical Evaluation Unit
    Note
  • Review the content

29
109H - Are You Ready For Tracers?
  • Informed Consent
  • Verify that you are still under the Notes tab.
  • Choose the note, Informed Consent note.
  • Review the content of the note laterality is
    not addressed.
  • Open the IMED Consent.
  • Choose Tools on the dropdown menu.
  • Select VistA Imaging Display.
  • Select the IMED consent for Left Inguinal Hernia
    Repair.

30
109H - Are You Ready For Tracers?
  • Universal Protocol
  • Verify that you are still under the Notes tab.
  • Choose the note, Procedure Patient Site
    Verification note.
  • Compare the content of this note with the
    requirements
  • Involves the entire operative team, uses active
    communication and includes at least
  • Correct patient identity
  • Correct side and site
  • Agreement on the procedure to be done
  • Correct patient position
  • Availability of implants or special equipment, if
    appropriate

31
109H - Are You Ready For Tracers?
  • Coordination of Care
  • Medical Care
  • Click on the Notes tab
  • Choose the General Surgery Resident Note.
  • Review the content of the note

32
109H - Are You Ready For Tracers?
  • Coordination of Care
  • Nursing Care
  • Choose the Nursing Reassessment note.
  • Find the plan by using the search function.
  • Right click within the note.
  • Choose Find in Selected Note.
  • Type in Plan and choose, Find Next.
  • This takes us directly to the plan.
  • Using the Find in Selected Note function,
    replace plan with activity
  • Click on Find Next
  • This takes us to the current activity of the
    patient

33
109H - Are You Ready For Tracers?
  • Hand-off Communication
  • Hand-offs
  • Surgical Evaluation Unit to Surgery
  • Surgery to the inpatient unit
  • Shift to shift during the inpatient stay
  • Communication
  • Click on the Notes tab.
  • Chose the Nursing Surgical Evaluation Unit
    note.
  • Review the note.

34
109H - Are You Ready For Tracers?
  • Critical Test Value
  • Click on the Labs tab
  • The result that appears is the Potassium (K)
    value of 4.5
  • Click on Previous to obtain the result of 2.9.
  • Go to the Comments section at the bottom of
    screen

35
109H - Are You Ready For Tracers?
  • Verification of Ordering Provider
  • Click on the Orders tab.
  • This order has been completed so on the toolbar,
    drop down the menu for View.
  • Choose Custom Order View.
  • Choose Completed/Expired on the left hand side
    and Laboratory on the right hand side.
  • Double click on the order for Potassium dated
    4/28/08.
  • Fourth line down, look for Ordered by and find
    Provider, One.

36
109H - Are You Ready For Tracers?
  • Verbal Orders
  • Click on the Orders tab.
  • On the toolbar, drop down the menu for View.
  • Choose Custom Order View.
  • Choose Completed/Expired on the left hand side
    and Pharmacy on the right hand side.
  • Find the order for Potassium in the Inpatient
    Section.
  • Note read-back documentation.

37
109H - Are You Ready For Tracers?
  • Pain Management
  • Click on the Notes tab.
  • Choose the Nursing Reassessment note.
  • Note the pain score of 6 at 1600.

38
109H - Are You Ready For Tracers?
  • Order for Pain Medication
  • Click on the Orders tab.
  • On the toolbar, drop down the menu for View.
  • Choose Custom Order View.
  • Choose Completed/Expired on the left hand side
    and Pharmacy on the right hand side.
  • Look in Inpatient Medications to find an order
    for Codeine30/Acetaminophen 300mg.
  • Note that the order is written for one or two
    tablets.

39
109H - Are You Ready For Tracers?
  • Medication Administration
  • Click on the Reports tab.
  • On the left hand side of the screen, choose Med
    Admin Log.
  • Go down to the next box and click on Six Months
    Back.
  • Scroll down to find Codeine30/Acetaminophen
    300mg.
  • Note the date/time med was given.
  • Note PRN Effectiveness entry.
  • Click on the Notes tab.
  • The Nursing Reassessment note should appear on
    your screen.
  • Two lines below the vital signs you will notice
    the entry for LOC.
  • Current pain score is 0.
  • The time of the note is 1645.

40
109H - Are You Ready For Tracers?
  • Assessment of Surgical Wound
  • Click on the Notes tab.
  • Choose the Nursing Reassessment note.
  • Right click within the note.
  • Choose Find in Selected Note.
  • Type in Skin and choose, Find Next.

41
109H - Are You Ready For Tracers?
  • Discharge Planning
  • Click on the Notes tab.
  • Choose the Nursing Admission Assessment note.
  • Right click within the note and select Find in
    Selected Note.
  • Type in psychosocial and click on Find Next.
  • Note there are no concerns about returning home.
  • Type in home and click on Find Next.
  • There are no special concerns in the assessment
    of his home living situation.

42
109H - Are You Ready For Tracers?
  • Discharge Instructions
  • Verify that you are still working under the
    Notes tab.
  • Choose the Nursing Discharge Instructions.
  • Review the content of the note.
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